Analysis of Subanesthetic Doses of Esketamine and Propofol in Three-dimensional Afterloading Treatment of Cervical Cancer
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摘要:
目的 观察亚麻醉剂量艾司氯胺酮联合丙泊酚麻醉在宫颈癌三维后装治疗中的应用效果。 方法 选取昆明医科大学第三附属医院2022年2月至2023年1月行宫颈癌三维后装治疗的患者100例，随机分为2组，每组50例。S组为对照组，采用舒芬太尼联合丙泊酚进行麻醉，E组为实验组，采用艾司氯胺酮联合丙泊酚进行麻醉，记录2组患者的手术时间、苏醒时间、术中呼吸系统不良事件的发生率、术后不良事件的发生率、在同时间点的生命体征变化以及麻醉满意度。 结果 2组对象置管时间、苏醒时间比较差异无统计学意义（P > 0.05）。E组的HR次数较S组更高（ F = 12.353，P = 0.001），且不同时间HR次数不同（F = 6.637，P = 0.002）；在MAP的结果中显示，E组的MAP较S组更高（F = 11.245，P = 0.001），且不同时间MAP不同（F = 17.023，P < 0.001），但不存在组别与时间的交互效（ F = 1.861，P = 0.159）；在SpO2的结果中显示，E组的SpO2较S组更高（F = 4.960，P = 0.027），且不同时间SpO2不同（F = 183.045，P < 0.001），但不存在组别与时间的交互效应（ F = 0.054，P = 0.947）。2组不同时间点的对象VAS评分没有统计学意义（P > 0.05）。术中不良事件中E组患者的低血压（MAP≤65 mmHg）或血压下降幅度≥20%、术中给予血管活性药的发生率均低于S组（ P < 0.05），E组患者的精神症状发生率高于S组（ P < 0.05）。2组麻醉满意率对比差异无统计学意义（ P > 0.05）。 结论 艾司氯胺酮联合丙泊酚麻醉在宫颈癌三维后装治疗中血流动力学平稳，相对于舒芬太尼联合丙泊酚麻醉有较好的镇痛作用，但术后精神症状发生率较高。 Abstract:Objective To investigate the effects of combined subanesthetic doses of esketamine and propofol anesthesia in three-dimensional after loading treatment of cervical cancer. Methods One hundred patients who received three-dimensional afterloading treatment for cervical cancer in our hospital between February 2022 and January 2023 were randomly divided into two groups, with 50 cases in each group. Patients in the control S group received Sulfentany combined with propofol for anesthesia, while those in the experimental E group received esketamine together with propofol. The duration of surgery, wake-up time, the incidence of intraoperative respiratory adverse events, the incidence of postoperative adverse events, changes in vital signs at the same time point, and a self-reported satisfaction survey were recorded for both groups of patients. Results There was no significant difference between the two groups in terms of operation time and wake-up time （P > 0.05）. The effects of anesthetic and time on heart rate （HR）, mean arterial pressure （MAP）, and oxygen saturation （SpO 2） were analyzed by two-way ANOVA. It was found that HR was higher in the E group than in the S group （F = 12.353, P = 0.001）, and the HR differed significantly at different times （F = 6.637, P = 0.002）. The MAP was also significantly higher in the E group compared with the S group （F = 11.245, P = 0.001）, and also differed at different times （F = 17.023, P < 0.001）, although there were no interactive effects between group and time （ F = 1.861, P = 0.159）. Both group and time were observed to affect the SpO2, which was higher in the E group than in the S group （F = 4.960, P = 0.027） and also differed significantly at different times （F = 183.045, P < 0.001）, although no interactive effects between group and time were observed （ F = 0.054, P = 0.947）. No significant differences in the visual analog scale （VAS） scores were found between the two groups at different time points （P > 0.05）, and both anesthesia methods had good analgesic effects. In terms of intraoperative adverse events, the incidence of hypotension （MAP ≤65 mmHg） or a decrease in blood pressure of ≥20% and requirements for vasoactive drug administration during surgery were lower in the E group than in the S group （ P < 0.05）, while the incidence of psychiatric symptoms was higher in the E group than in the S group （ P < 0.05）. As shown by the self-reported anesthesia satisfaction survey, all 100 patients were satisfied with the anesthesia, with no significant difference in the satisfaction rates between the two groups （ P > 0.05）. Conclusions The combination of subanesthetic doses of esketamine and propofol anesthesia in the three-dimensional after loading treatment of cervical cancer resulted in stable hemodynamics, good analgesic effect, and patient satisfaction. However, the incidence of postoperative psychiatric symptoms was higher compared to the control group. -
Key words:
- Subanesthetic /
- Esketamine /
- Propofol /
- Three-dimensional after loading treatment /
- Cervical cancer
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表 1 2组患者一般情况的比较[（ $\bar x \pm s $）/n（%）]
Table 1. Comparison of the general condition of the patients between the two groups [（ $\bar x \pm s $）/n（%）]
项目 E组 S组 t/χ2 P 例数（n） 50 50 年龄（岁） 45.16 ± 13.82 42.58 ± 11.95 0.701 0.487 BMI（kg/m2） 23.04 ± 2.70 23.35 ± 2.79 0.394 0.695 高血压病例 10（20.00） 12（24.00） 0.233 0.629 糖尿病例 4（8.00） 5（10.00） 0.000 0.999 
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表 2 2组置管时间、苏醒时间的比较（ $\bar x \pm s $）
Table 2. Comparison of the duration of surgery，the wake-up time between the two groups （ $ \bar x \pm s$）
项目 E组 S组 t P 例数（n） 50 50 置管时间（min） 12.04 ± 3.04 12.00 ± 2.50 0.050 0.960 苏醒时间（min） 6.80 ± 2.22 7.62 ± 2.15 1.304 0.198
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表 3 2组HR、MAP、SpO2的比较（ $ \bar x \pm s$）
Table 3. Comparison of HR，MAP，and SpO2 between the two groups （ $\bar x \pm s $）
指标 S组 E组 组别主效应 时间主效应 组别*时间 F P F P F P HR（次/min） T1 74.19 ± 5.80 74.44 ± 8.18 12.353 0.001* 6.637 0.002* 3.457 0.034* T2 64.62 ± 5.63 72.72 ± 8.34 T3 70.08 ± 8.64 74.76 ± 8.55 MAP（mmHg） T1 90.73 ± 8.21 91.88 ± 11.51 11.245 0.001* 17.023 < 0.001* 1.861 0.159 T2 76.23 ± 10.07 84.52 ± 9.10 T3 84.38 ± 6.47 90.56 ± 10.16 SpO2（%） T1 95.68 ± 1.80 96.00 ± 1.33 4.960 0.027* 183.045 < 0.001* 0.054 0.947 T2 99.2 ± 0.40 99.58 ± 0.74 T3 99.08 ± 0.48 99.54 ± 0.80 与S组比较，*P < 0.05。 HR：心率； MAP：平均动脉压； SpO 2：脉搏血氧饱和度。
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表 4 不同时间点的VAS评分（ $\bar x \pm s$）
Table 4. Comparison of VAS scores at different time points between the two groups （ $\bar x \pm s$）
时间 E组 S组 t P 苏醒时 0.24 ± 0.66 0.39 ± 0.57 0.835 0.408 苏醒后30 min 0.56 ± 0.96 0.96 ± 1.04 1.432 0.159 苏醒后1 h 1.04 ± 1.37 1.39 ± 1.60 0.827* 0.412 *表示2组方差不齐，使用校正t检验。
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表 5 各项指标组间比较[n（%）]
Table 5. Comparison of the various indicators between the two groups [n（%）]
指标 E组 S组 χ2 P 术中体动 2（4.00） 4（8.00） 0.177 0.674 术中追加丙泊酚 2（4.00） 4（8.00） 0.177 0.674 低血压（MAP≤
65 mmHg）或
无创血压下降
幅度≥20%8（16.00） 19（38.00） 6.139 0.013* 术中给予血管活性药 8（16.00） 19（38.00） 6.139 0.013* 阿托品 0（0.00） 2（4.00） 0.510 0.475 麻黄碱 8（16.00） 17（34.00） 4.320 0.038* 术中呼吸系统不良事件 0（0.00） 2（4.00） 0.510 0.475 呼吸抑制 0（0.00） 2（4.00） 0.510 0.475 术后不良事件 视力模糊 3（6.00） 4（8.00） 0.000 0.999 恶心 10（20.00） 12（24.00） 0.233 0.629 头晕 4（8.00） 5（10.00） 0.000 0.999 心悸 2（4.00） 3（6.00） 0.000 0.999 精神症状 3（6.00） 0（0.00） 6.139 0.013* *P < 0.05。
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表 6 自制麻醉效果评价满意度调查表[n（%）]
Table 6. Self-made satisfaction questionnaire for the evaluation of anesthesia effect [n（%）]
项目 E组 S组 χ2 P N 50 50 满意 50（100.00） 50（100.00） 0.000 > 0.999 不满意 0（0.00） 0（0.00） 0.000 > 0.999
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